BODY: Ever since rival
Democratic and Republican bills to provide Medicare prescription
drug coverage for the elderly went down to defeat in the Senate last week,
anxious senators have been scrambling to find a compromise that might attract
the 60 votes needed to assure passage. The Democrats feel a particular urgency
to pass a bill given that the Republican-controlled House has already done so.
But several Senate Republicans in tough re-election campaigns also want to come
up with something to parade before the elderly in the fall campaigns. It is
critical that enough bipartisan support be found to push through a meaningful
drug benefit this week before the Senate begins its August recess.
At the close of last week, two major alternatives had
emerged as possible compromises. Each would cost substantially less than the
Democratic bill that went down to defeat last week because its eight-year
$594-billion price tag proved too much for the Senate to swallow. Even so, the
two alternatives under discussion would cost at the very least $400 billion over
the same period.
One alternative, which Senators Bob
Graham, Democrat of Florida, and Gordon Smith, Republican of Oregon, plan to
introduce this week, would provide virtually complete coverage of all drug
purchases for low-income Americans except for a nominal co-payment. For everyone
else, there would be discount cards projected to shave 20 percent or more off
the price of prescription drugs and a limit of $4,000 in out-of-pocket spending,
after which the federal government would pay everything but a small co-payment
per prescription. The great virtue of this approach is that it focuses help
where it is most needed -- on low-income individuals and those with high drug
bills.
The other leading alternative would build on the
Republican-backed "tripartisan" bill that also went down to defeat last week,
but would sweeten it to attract more Democratic support. In one preliminary
version, low-income Americans would get substantially complete coverage, while
everyone else would share the costs 50-50 with the federal government until
reaching a $6,000 limit, after which the government would pick up 90 percent of
the cost. The plan would rely on private insurers to keep costs down through
competition. Senators who are worried about the reaction of middle-class elderly
voters -- a critical constituency that turns out heavily in off-year elections
-- will probably find this approach appealing.
We
prefer a bill with a lower limit on catastrophic coverage. While it's impossible
to really compare legislative proposals that have yet to be submitted in writing
or subjected to the same objective analysis of their cost, the guidelines should
be clear: It is more important to protect people completely with thousands of
dollars in prescription expenses than to dole out bits of aid to those whose
bills run in the hundreds.
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